A325 – Limited Consultation
OHIP General Listings Code — Genetics (22) · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician’s time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation.
When to Use
- Use A325 for a focused genetic assessment of a single, well-defined issue, such as interpreting a specific genetic test result for a patient with a known condition.
- Bill A325 when the patient presents with a new, isolated genetic concern that requires a brief expert opinion, distinct from a more comprehensive assessment (A225) or a lengthy specialized consultation (A220, A223).
- A325 is appropriate for a follow-up genetic opinion on a distinct, unrelated genetic issue that arises more than 12 months after a previous consultation for a different condition.
Common Pitfalls
- Billing A325 for a service that meets the criteria for a full consultation (A225) or a special genetic consultation (A220, A223) will result in rejection or payment at the lower assessment fee (A221).
- Failure to obtain and retain a signed written request from the referring provider, clearly outlining the patient, referrer, and specific information required, is a common reason for claim rejection.
- Not submitting a written report to the referring provider detailing findings, opinions, and recommendations will lead to the claim being reduced to the A221 fee.
Billing Tips
- Ensure the written request specifies the limited scope of the consultation, differentiating it from a full consultation (A225) to justify the A325 code.
- When billing for virtual care, always append the 'A' suffix to the A325 code and confirm the consultation was conducted via video.
Effective: June 1, 2025
Consultations and Visits
Genetics (22)
Consultations and Visits
Consultation
A limited consultation is defined by being less demanding and requiring substantially less time than a full consultation (A225).
If the consultation is requested by a Medical Trainee, the fee is adjusted to a general or specific assessment fee.
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